Four Largest United States For-Profit Health Insurers Increase Coverage Denials Based on Pre-existing Condition

By Bonny Rafel

A Congressional investigation released last month found that the four largest U.S. for-profit health insurers denied policies to one in every seven applicants based on prior medical history. The Wall Street Journal reported the companies – Aetna, Inc., Humana, Inc., UnitedHealth Group, Inc., and WellPoint, Inc. – denied coverage to more than 651,000 people over the three-year period from 2007 to 2009 based on pre-existing medical conditions. The numbers indicated a 49% rise in the number of people who were denied coverage based on a pre-existing condition over the last two years.

Bloomberg reported that while most Americans have health coverage through their employer or Medicare, there is an estimated 15.7 million adults under age 65 who receive coverage through an individual health insurance policy. These are the customers directly affected by pre-existing condition coverage denials. During the same three-year period of 2007 to 2009, the four carriers combined to deny 212,800 medical claims based on the companies’ claims that these claims resulted from a pre-existing condition.

While this number is alarming, it is important to note that under the newly passed health-care legislation, insurers will no longer be able to deny coverage because of a pre-existing health condition beginning in 2014.Contributed by Charles Kellett, Esq. associate with Bonny G. Rafel